What is Peripheral Arter Disease? Peripheral Arte Disease (PAD) is also known as athero- sclerosis, poor circulation, or hardening of the arteries. PAD progresses over time at variable rates in each individual de- pending on the area of circulation affected and one’s health and family history. The signs and symptoms of PAD may not arise until later in life. For many, the outward indications will not appear until the artery has narrowed by 60 percent or more. One method the body uses to adapt to the narrowed arteries is the development of smaller peripheral arteries that allow blood flow around the narrowed area. This process is known as collateral circulation and may help explain why many can have PAD without feeling any symptoms. When a piece of cholesterol, calcium or blood clot abruptly breaks from the lining of the artery or a narrowed artery blocks off completely, blood flow will be totally obstructed and the organ supplied by that artery will suffer damage. The organs in PAD most commonly affected and researched are the legs. Peripheral Arter Disease What happens if the disease worsens? The severity of PAD depends on when it is detected and any pre-existing health factors; especially smoking, high cholesterol, heart disease or diabetes. In the later stages, leg circulation may be so poor that pain occurs in the toes and feet during periods of inactivity or rest. This is especially true at night. This is known as rest pain, which usually worsens when the legs are elevated and is often relieved by lowering the legs (due to the effects of grav- ity on the blood flow). Crical Limb Ischemia The most advanced stages of PAD can lead to Critical Limb Ischemia (CLI). Here the legs and feet have such severe blockage that they do not receive the oxygen rich blood required for growth and repair of painful sores and even gangrene (dead tissue). This condition, if left untreated, may require amputation. To find out more about the Vascular Disease Foundation, call 888.833.4463 or visit us online at www.vasculardisease.org Risk Factors An individual is at risk for developing PAD when one or more of these risk factors are present: Smoking - This is the number one risk factor for PAD. Those that smoke not only put themselves at risk for developing arterial disease but also undermine aempts at treatment. Diabetes - Individuals with diabetes are at a greater risk for developing PAD due to its effect on blood vessels. History of Heart Disease - A family history of cardio- vascular disease is an indicator for developing PAD. Hypertension (high blood pressure) - When blood pressure remains high, the lining of the artery walls becomes damaged. Many PAD paents also have high blood pressure. Age - In the United States, those 50 years or older are at greater risk to develop PAD. PAD affects both men and women, but occurs slightly more in men. The percentage of elderly people that are affected is: Age % Affected 40-59 3% 60-69 8% 70 or older 19% High levels of Homocysteine - This is an amino acid found in plasma (blood). Some recent studies show higher levels are associated with PAD.
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What is Peripheral Arterȅ Disease?Peripheral Artery Disease (PAD) is also known as athero-sclerosis, poor circulation, or hardening of the arteries. PAD progresses over time at variable rates in each individual de-pending on the area of circulation affected and one’s health and family history. The signs and symptoms of PAD may not arise until later in life. For many, the outward indications will not appear until the artery has narrowed by 60 percent or more. One method the body uses to adapt to the narrowed arteries is the development of smaller peripheral arteries that allow blood flow around the narrowed area. This process is known as collateral circulation and may help explain why many can have PAD without feeling any symptoms. When a piece of cholesterol, calcium or blood clot abruptly breaks from the lining of the artery or a narrowed artery blocks off completely, blood flow will be totally obstructed and the organ supplied by that artery will suffer damage. The organs in PAD most commonly affected and researched are the legs.
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Peripheral Artery Disease
What happens if the disease worsens?The severity of PAD depends on when it is detected andany pre-existing health factors; especially smoking, highcholesterol, heart disease or diabetes. In the later stages,leg circulation may be so poor that pain occurs in thetoes and feet during periods of inactivity or rest. This isespecially true at night. This is known as rest pain, whichusually worsens when the legs are elevated and is oftenrelieved by lowering the legs (due to the effects of grav-ity on the blood flow).
Critical Limb IschemiaThe most advanced stages of PAD can lead to CriticalLimb Ischemia (CLI). Here the legs and feet have suchsevere blockage that they do not receive the oxygen richblood required for growth and repair of painful soresand even gangrene (dead tissue). This condition, if leftuntreated, may require amputation.
To find out more about the Vascular Disease Foundation, call 888.833.4463 or visit us online at www.vasculardisease.org
Risk FactorsAn individual is at risk for developing PAD when one or more of these risk factors are present:
Smoking - This is the number one risk factor for PAD. Those that smoke not only put themselves at risk for developing arterial disease but also undermine attempts at treatment.
Diabetes - Individuals with diabetes are at a greater risk for developing PAD due to its effect on blood vessels.
History of Heart Disease - A family history of cardio-vascular disease is an indicator for developing PAD.
Hypertension (high blood pressure) - When blood pressure remains high, the lining of the artery walls becomes damaged. Many PAD patients also have high blood pressure.
Age - In the United States, those 50 years or older areat greater risk to develop PAD. PAD affects both menand women, but occurs slightly more in men. Thepercentage of elderly people that are affected is:
Age % Affected40-59 3%60-69 8%70 or older 19%
High levels of Homocysteine - This is an amino acidfound in plasma (blood). Some recent studies showhigher levels are associated with PAD.
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SymptomsMost people do not have symptoms, but for many, the first noticeable symptom of PAD is a painful cramp-ing of leg muscles during walking called intermit-tent claudication. When a person rests, the cramping goes away. This leg pain can be severe enough to deter a person from normal walking. Some individu-als will not feel cramping or pain but might feel a numbness, weak-ness or heaviness in the muscles. In patients whose PAD is more severe, insufficient blood flow to the feet and legs may cause a burning/aching pain in the feet and toes while resting. The pain will occur particularly at night while lying flat. Other symptoms include:
• Cooling of skin in specific areas of legs or feet• Color changes in the skin and loss of hair• Toe and foot sores that do not heal
“Silent PAD”Many people are affected by PAD yet they do not havesymptoms. These individuals are at a high risk for suffer-ing an early heart attack or stroke. Research has proven that the life expectancy for a person with PAD is greatly reduced. For example, the risk of dying from heart disease is six times higher for those with PAD compared to those without. Therefore, it is important to discuss the possibil-ity of PAD with a health care professional if someone has several of the risk factors for PAD.
DiagnosisSeveral tests may be required to diagnose PAD and determine the extent of the disease. Some of these tests may be per-formed in a primary care physician’s office, whereas others may be performed by a vascular specialist or in a vascular lab. Most tests are non-invasive and thus should be fairly painless.
• Medical history and physical exam• Ankle-Brachial Index (ABI)• Treadmill Exercise Test• Reactive Hyperemia Test• Segmental Pressure Measurements• PVR Waveform Analysis• Duplex Arterial Imaging or Ultrasound Imaging• Photoplethysmography (PPG)• Arteriogram
TreatmentTreatment options vary and depend on the overall health of the patient and the severity of the diagnosis. The health care provider should provide the patient with adequate information to help understand all options. The majority of intermittent claudica-tion cases are treated without surgery. A treatment plan usually involves lifestyle changes and one or more of the following:
• Exercise therapy• Lifestyle modifications• Medication• Diet• Smoking cessation• Diabetes management• Blood pressure management• Foot care• Endovascular therapy• Vascular surgery
The Vascular Disease FounDaTion
Established in 1998, the Vascular Disease Foundation (VDF) develops educational information and initiatives for patients, their families and friends, and health care providers regarding often ignored, but serious vascular diseases. In fact, VDF is the only multidisciplinary national public 501(c)(3) non-profit organization focused on providing public education and improving awareness about vascular diseases.For more information, visit vasculardisease.org.
Help the Vascular Disease Foundation continue to make this critical educational information available. Your contribution will make saving lives a greater reality. Make a donation today at: contact.vasculardisease.org/donate
To find out more about the Vascular Disease Foundation, call 888.833.4463 or visit us online at www.vasculardisease.org
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